Evengård, Birgitta, Jonzon, Eva, Sandberg, Anneli et al. · Psychiatry and clinical neurosciences · 2003 · DOI
This study compared two groups of people with severe, long-lasting fatigue seen at an infectious disease clinic in Sweden: those who met criteria for ME/CFS and those with chronic fatigue (CF) but not ME/CFS. The main finding was that ME/CFS patients reported more physical symptoms and work disability, and most had a sudden onset following an infection, whereas CF patients had more mental health symptoms and a more gradual, burnout-like pattern. The researchers suggest these may be two different conditions with different underlying causes.
This study addresses a critical clinical question: whether ME/CFS and chronic fatigue represent distinct disease entities or points on a continuum. The finding that 80% of ME/CFS cases had acute infectious onset supports an organic pathogenic mechanism in ME/CFS and helps differentiate it from CF with psychiatric features, informing both diagnostic approaches and potential treatment strategies.
This study does not prove that ME/CFS and CF have different underlying biological causes—it only demonstrates that they differ in presentation and comorbidity patterns. The acute infectious onset in ME/CFS is reported by patients retrospectively and is not independently verified. The cross-sectional design cannot establish causation or determine whether psychiatric symptoms in CF patients preceded or resulted from chronic fatigue.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Evengård, Birgitta, Jonzon, Eva, Sandberg, Anneli, Theorell, Töres, & Lindh, Gudrun (2003). Differences between patients with chronic fatigue syndrome and with chronic fatigue at an infectious disease clinic in Stockholm, Sweden.. Psychiatry and clinical neurosciences. https://doi.org/10.1046/j.1440-1819.2003.01132.x
BibTeX
@article{mecfsatlas-evengrd-2003-differences-between,
author = {Evengård, Birgitta and Jonzon, Eva and Sandberg, Anneli and Theorell, Töres and Lindh, Gudrun},
title = {Differences between patients with chronic fatigue syndrome and with chronic fatigue at an infectious disease clinic in Stockholm, Sweden.},
journal = {Psychiatry and clinical neurosciences},
year = {2003},
doi = {10.1046/j.1440-1819.2003.01132.x},
note = {PubMed: 12839515},
url = {https://www.mecfsatlas.com/evidence/evengrd-2003-differences-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/evengrd-2003-differences-between
Contribute
Private, reviewed by a human. Not a public comment thread.